The adrenal glands are pretty much ignored by mainstream medicine — but they shouldn’t be.

While your adrenal glands are small — about the size of a pair of dice — they make and help balance over 50 hormones. Leading the list are cortisol, and vital mineral corticoids like aldosterone, epinephrine and norepinephrine, along with other key hormones.

But conventional medical doctors don’t really address adrenal function unless it’s totally shut down as in Addison's disease, or when the adrenals are pumping out crazy amounts of cortisol as in Cushing's disease.

But I'm here to tell you that adrenal fatigue is real! I've personally experienced and overcome it myself and I've helped thousands of patients recover from adrenal fatigue. Here’s why it’s important to understand adrenal fatigue – along with answers to frequently asked questions about the problem.

With adrenal function, you don’t instantly go from healthy to sick

Adrenal health occurs over a wide range. On one hand, there is excess adrenal activity with Cushing's disease and, on the other hand, there is under-functioning with Addison's disease.

But there's a whole realm in the middle where the function and regulation of our internal systems are happening. And adrenal fatigue falls into a spectrum, too, because we don't just go from being healthy to being sick. It's more of a journey. With natural medicine, we look for the options that allow us to turn around when we’re headed toward disease, because that is not where we want to go.

If your own doctor is telling you you're crazy or that adrenal fatigue doesn't exist, then maybe it's time to look for a naturopathic physician or a functional medicine doctor for help.

What are the main symptoms of adrenal fatigue?

Adrenal fatigue can generate a lot of symptoms! From anxiety, fatigue and low blood sugar to headaches, sleep disturbances, allergies, weight gain and more — it’s a long list.

Low blood pressure can be an adrenal fatigue symptom too. A lot of times the doctor is worried about your blood pressure being high and when it’s low — like 90 over 60 — you’re told, “that’s great!” But, it really isn’t so great because it means there could be an issue with your adrenals, and possibly even your thyroid.

Another big adrenal fatigue clue? If you often crash in the afternoon. Every day you may get up and get going and everything's okay until: BAM! A couple hours after lunch around three o'clock, you just want to lie down and take a nap.

Another very common symptom is having a hard time managing stress. Maybe things that never bothered you before really bother you now. For example, if you're on the phone on hold for a long time, or maybe you’re driving and there’s a red light, and you freak out.

Women with adrenal issues often have sleep and caffeine issues

For so many of us, it's not just that we enjoy our cup of coffee in the morning or that it's a comforting ritual we like. Instead, it's that we need that caffeine to function! Without your cup of coffee you're sure you’re going to be lying on the couch all day. You know, when a horse is super tired and he is just plodding along but then you whip him, he’s going take off and run even if he’s exhausted.

It's the same thing with your adrenal glands. If you’re tired and you introduce caffeine, it will wake up your adrenal glands and you're going to feel as if you have energy. But it's false energy. And instead, that energy boost is going to lead to an energy crash.

I'll also hear about sleep issues from my patients. They say: I fall asleep easily but then I wake up and I can't get back to sleep. Others have difficulties maintaining any chiropractic adjustments. Maybe you get adjusted and then 12 hours later, your neck or hip is out again and you need to go back.

Sometimes with adrenal fatigue, you might also get sick a lot and then have a harder time recovering than you usually do.

How is adrenal fatigue different from just being tired all the time?

There are many different reasons you could be tired. When tired patients come to see me, I'm certainly looking at a differential diagnosis to find the cause. Adrenal fatigue is definitely in there as a possibility right from the start, but the tiredness could also be due to anemia. Or it could be due to a sluggish thyroid, as the thyroid and the adrenals are intimately connected.

Here’s an important functional medicine tip if you are being treated for a thyroid dysfunction with a thyroid hormone: make sure you have your adrenals tested. Treating the thyroid without supporting the adrenals will further deplete the adrenals. So always be sure to ask to have your adrenal function looked at as well.

You could also be tired all the time because you’re iron-anemic and need to have a full iron blood panel done. Maybe you're tired because you're burning the candle at both ends and just not getting enough sleep. Or you might be tired because you're not getting enough physical activity. You could also be stressed out and emotionally drained.

Because there are so many different reasons for being tired, getting the proper diagnosis is important so you can get the proper treatment.

Watch Dr. Stills answer the most common questions about adrenal fatigue

How is someone diagnosed with adrenal fatigue?

I have different ways that I can piece together information to identify whether the adrenals are in trouble. One story I hear so often is when a patient tells me, “I have a hard time getting out of bed in the morning. Then I drink my coffee and I feel great. But I crash around 3:00 and I have to have another cup of coffee or some sugar for a boost. I get home from work and I'm exhausted, but then lo and behold, I have so much energy at 9:00 PM, I'm ready to scrub the floors, vacuum the house, do the dishes, answer my emails and go for a run!”

That scenario is because of the second wind that you get from the adrenal glands, and it’s a real sign that you have problems. Some of the functional tests I do to find out more include:

Paradoxical pupillary response

I turn the lights out for about 15 seconds make the room dark and then come in with a light that I shine on the patient’s pupil. If the pupil constricts and it’s maintained for 20 seconds, then I know she has a pretty good adrenal reserve.

If there's no constriction, or there's a constriction and then an immediate dilation of the pupil, I know there are serious problems going on. Also, with adrenal fatigue, you'll be very light-sensitive, so if a patient has on her sunglasses — even in my office — that's a tip that there's an issue.

Postural hypertension test

When the patient is lying on her back, I take her blood pressure. I'm looking mostly at the systolic number, or the top number. If your blood pressure is 120 over 80, 120 would be your systolic number.

Here’s why: another symptom of adrenal issues getting dizzy upon rising from a sitting position. I have the patient stand up, and within five seconds of her standing, I'm pumping up the cuff again to see what the systolic reading is. With normal adrenal health, the systolic reading would go up about five to ten points. If it stays the same, I know there's an issue. If the reading drops 10 points, that also means there's a problem. If it drops 20 points, I know there's a serious adrenal issue.

Adrenal stress index testing (saliva testing)

This test is a very accurate way to look at the daily rhythm of the adrenal glands. In the morning, cortisol secretion should be high. It's what wakes us up, gets us out of bed, gets us going “rah rah rah,” Then as the day goes on, the levels should slowly drop.

I often explain it as being on a ski lift. When you go skiing, you take the lift to the top of the mountain, and it’s like that when your cortisol is high in the morning. You ski down the slope and by the time you're at the bottom, it's time to go to bed and your cortisol levels are low. And while you're sleeping, you get on the ski lift again and your cortisol levels rise again.

The problem is, we can't really look at that diurnal (daily) rhythm in a blood test, and that's why I do saliva testing. It can show that cortisol levels are really low in the morning but then go crazy-high at night. That makes it easier for me to give the right treatment at the right time.

Blood work

From the right blood work, I can see low aldosterone, low BUN (a kidney marker), low CO2 and sodium and chloride levels. I also do a Potassium RBC test.

Top 3 things you can do to feel better if you have adrenal fatigue

1. Sleep and rest

Honoring the rhythm of your body by not over-booking yourself or making your calendar so busy that you go from here to here to here is the most important step. This morning, I was in yoga, I was resting in Savasana (Corpse Pose) after the practice, taking in the energy and absorbing all the work that I had just done in the class.

I was lying there thinking how grateful I am that I set up my schedule so I don't have to run out of the yoga studio because I see so many people rushing to their next thing. But that really stresses the adrenal glands. So take the time to rest.

Also, make sure you sleep during the right hours. Be in bed and sleeping by 10:00 or 10:30 PM. at the latest. If you need to unwind, or it takes you a little bit to fall asleep, then get to bed at 9:00 or 9:30 PM.

When you have adrenal fatigue, it's important to establish a firm sleeping schedule and stick to it, whether it's during the work week or on the weekend. Honoring your sleep, and getting it at the right time, will really help to renew your adrenal glands.

2. Avoid caffeine

We don't want to whip the adrenals just like we don’t want to whip that horse. If your adrenals are tired, you need to let them build back up naturally. If you keep doing the caffeine, not only are you masking what's going on, but you're making it worse, Caffeine takes you up but then it drops you way down. So avoid caffeine and get hydrated. I just love hydrating! Make sure you get at least half your weight in ounces daily, preferably getting up to three liters (about 101 ounces) every day.

The adrenals really need B complex vitamins and vitamin C. Sometimes it’s good to just let the adrenals rest a little while taking adaptogenic herbs, like ashwagandha or holy basil. These yummy herbs help the adrenals repair themselves. It’s kind of like letting your adrenals go lie in a hammock for a little while you take some high quality nutrients.

Healing your adrenals is possible but it takes time

Also try to remember that healing your adrenal glands is not an overnight thing.

My own adrenal fatigue happened years ago and I still have to be very mindful of my lifestyle. If I stay out too late, I can feel it, but I look at that as a blessing. It helps me stay on the path of taking good care of myself and honoring my needs. Don’t expect this to be a one-time quick fix, and think, “oh I'm going to stop caffeine and sleep for a month and then I'm going to be better.”

Remember, it took a lot of time for your adrenals to get where they are and it's going to take time to heal them. So be kind to yourself, be proactive about the things I’ve talked about and know that you will be well again!

You may be suffering from an adrenal imbalance and not even realize it. Our quick quiz can help you make sense of your symptoms.